Ethics in the News

On being yourself

‘I was always the life and soul of the party, flirting with everyone’, wrote Lucille Howe, in ‘Fabulous Magazine’, (22 July 2012), ‘but I wanted John to fall in love with the real, quieter me’. In the same article, Charlotte Ruhle notes how her psychotherapy helped her to recover from a broken relationship. ‘[My] friends started saying I….seemed more like my old self.‘
The media, and indeed our ordinary conversations, are awash with this sort of language. Not only are we conscious – having a sense that there is an ‘I’ that is in some sort of continuity with the ‘I’ that existed yesterday, will hopefully exist tomorrow, and to whom things happen – but we have firm convictions about the nature of the ‘I’. When it is not allowed to express itself – to ‘be itself’, we complain. Depending on our education, we say that we’re ‘out of sorts’, ‘not myself’, or ‘ontologically vertiginous’.
The notion of a core self with defined characteristics pervades our ethics and our law. Someone can be compulsorily treated for psychiatric illness if he’s not in his ‘right mind’ (not a legal expression, but a fair gloss). The patient with anorexia nervosa, discussed here, is being force-fed, despite her expressed wish to die, because, in the court’s view, it’s not really ‘her’ who seeks death. A surgeon might be persuaded to lop off the limbs of a patient with Body Image Dysphoria until the patient’s body represents the view she has of ‘himself’. Advance Directives and the notion of substituted judgment grope clumsily towards the fulfilment of the wishes of a notional ‘I’.
Pervasive though this notion is, it is rarely (although it is increasingly [1]) identified and discussed. We tend simply to say: ‘Autonomy’s the guiding principle’. While of course respect for autonomy is an essential ingredient of decent ethical and legal decision-making, often the injunction ‘Respect autonomy’ will be hopelessly question-begging. We all agree that there are some situations in which autonomy should not be respected. Usually this is where the exercise of X’s autonomy will cause harm to Y. Often, of course, X and Y occupy different bodies. But often they don’t. And where they don’t, we have to ask some unavoidably metaphysical (yes, I know it’s an obscene word in modern philosophy) questions along the lines of: ‘Which is the authentic self? Whose autonomy interests should prevail?’
Once we’re alive to this issue, we’ll see it everywhere. Not because we’re philosophically hallucinating, but because it really is everywhere. Whenever anyone invokes the idea of autonomy, our reflex should be: ‘Whose autonomy? Which is the authentic self whose interests should be protected?’
The second part of this question is most obviously pertinent when the competing factions share a skin and a brain. But they’re not restricted to that situation. We’re all inevitably, and by definition, relational beings. We can only be defined in terms of the nexus of relationships in which we exist and of which, to a large extent, we consist. Hence the authentic ‘I’ whose autonomy interests should trump the autonomy interests of the co-habiting ‘false I’, might well give its primary address as ‘Society’, or ‘Family’, or a particular religion. Sometimes the competition will be felt by the person herself. She has to decide whether to live or die, but who has the casting vote? The her that is a doting mother, for whom seeing her children for an extra day is everything? The her that is a tired patient, at the end of her tether? The her that is a religious Jew, nervous of usurping a divine prerogative? Where the person can feel and sufficiently appreciate the fact and nature of the competition, she (of course) is best placed to adjudicate on the submissions made by the various voices. But sometimes such introspection and self-adjudication will be impossible. That may be because cognition is medically or temperamentally impossible, or because the issues are simply too complex (and aren’t they usually?). What’s to be done then? Well then, obviously, a discussion begins. With her, if she can join in. And, if she cannot, with all the other people conventionally involved in discussions about decisions made on behalf of a third party. But conventionally left off the agenda of those discussions, and of discussions involving capacitous patients, are centrally important issues relating to the real identity of the person by or on whose behalf a decision is made.
[1] For recent examples, see Levy N, 2011, Enhancing authenticity. Journal of Applied Philosophy 28(3): 308-318, and Erler A, One man’s authenticity is another man’s betrayal: A reply to Levy, Journal of Applied Philosophy, Online First.

9 Responses to On being yourself

I’m pleased that the Bodleian subscribes to Fabulous Magazine, but I’m not quite sure what point you’re making in this post, Charles. Perhaps that demonstrates my intellectual limitations, or perhaps it would be easier to understand if I’d read the articles by N Levy and Erler (unfortunately my local library doesn’t have back-copies of the Journal of Applied Philosophy).
Is your point that difficult decisions are hard to take? Or that notions of identity are notoriously difficult to pin down? Or that we should indulge in metaphysics rather than try to make the best decisions we can, (which I would guess are always going to be a messy balance of best interest and substituted judgements and respect for advance directives)?

Thanks, Anthony. My only point for present purposes is that notions of identity are underdiscussed. We usually conduct conversations about medical decision-making (for example) as if we’re dealing with a simple entity called the person, whose characteristics and preferences are easily ascertainable. But things aren’t often so simple, and if we presume that they are, we’re likely to make blunderingly unnuanced judgments.

Very interesting supposition. Identity as a perspective. Today I’m happy. Today I’m sad. Today I’m healthy. Today I’m ill. Today I’m a football player. Today I’m a professor. Therefore my identity is X. Is identity a ‘choice’ then, whether voluntary or imposed by uncrontrollable influences? Is our identity subjective to context? A person crying for dismemberment is ill. Affectations such as ‘family’ or ‘religiosity’ are facets of identity only, are they not? If we have identified, and have consensus, verifiable medical ‘disorders’, are we ‘blundering’ in our decision-making when we cite those disorders in our decisions? Are we ‘this or that’ because of events we experience, diseases that attack us, or our level of discernment – or are we each humans in the highest order of known existence, infinitely nuanced, continuously and individually evolving to our environment while being reflective and interpretive of our experience, therefore exponentially varied and unique. What is another possible notion of our identity? That to identify us is an interpretation – subjectively determined with (currently) impossible accuracy. Administration of individuals is another matter.

Thanks for your reply, Charles. I think I agree … up to a point.
What I agree with completely is that « things aren”t often so simple », that the notion of a person is complex. But I seriously wonder whether we don’t reach the limits of philosophy in discussing « identity » in such cases. Let me give you a different case :
Antoine loves Mary, for a whole host of reasons that he would be hard-pushed to list, let alone justify, but which are clearly linked to the notion of the person that she is.
Some years later Mary has a stroke, leaving her aphasic and severely impaired intellectually. She is now Mary Mk2. Whilst hospitalised she is diagnosed wth an advanced cancer, which later metastizes to the brain. So a few months later we have Mary Mk3. And so on…
Should Antoine reflect metaphysically on the notion of who is the « real » Mary? Who was the Mary he loved all those years ago, who is the Mary of yesterday, and today, and tomorrow ? Or shouldn’t he rather just do what appears to be the best he can because he loves her ? (And who the real « her » is, doesn’t matter a toss.)
Fortunately Antoine is not a philosopher : he knows that the situation is complex, that there is no right answer to be determined by an ethicist’s formula, or a legislator’s vote. He’ll just do the best he can.

Perhaps, although not not known as a metaphysicist, Wittgenstein got it right : « One must transcend these propositions and then one will see the world aright »

“The patient with anorexia nervosa, discussed here, is being force-fed, despite her expressed wish to die, because, in the court’s view, it’s not really ‘her’ who seeks death.”

Is there supposed to be a link there somewhere, or a reference to a specific case? I can probably guess the case you mean, but I’d like to see the same source you had in mind when you wrote that sentence.

Anthony: many thanks. I have no advice for Antoine. But that doesn’t mean that the question I’ve identified isn’t important, or that someone other than Antoine might need, intellectually difficult and emotionally uncomfortable though it is, to come to some conclusions about ‘who’ the currently existing Mary is. If some earlier Mary has made an Advance Directive relating to the refusal of life-sustaining treatment, for instance, her clinicians or a judge might well be unable to dodge the question.

Thanks for your reply, Charles, but I don’t think Antoine is looking for advice.
One of the points I wanted to raise in citing his case is that anglo-saxon philosophy is marked by the striking absence of love and death in its discourse. Considering the importance of both in most people’s lives, this has always seemed strange to me.
Further, I think that the notion of love is able to maintain an identity of the loved one regardless of the changes in that person. As you often advocate a narrative approach, I’m surprised you disagree (but surely I’ve misunderstood your advocacy of narrative).
Finally, as understand it, the “Leonetti law” over here in France means that, fortunately, no judge or clinician is likely to be faced with the question in this case.

Anthony: thank you. You wrote originally: ‘Should Antoine reflect metaphysically on the notion of who is the « real » Mary? Who was the Mary he loved all those years ago, who is the Mary of yesterday, and today, and tomorrow ? Or shouldn’t he rather just do what appears to be the best he can because he loves her ? (And who the real « her » is, doesn’t matter a toss.)’ That rather sounded as if he were indeed looking for guidance. In refusing to give it I was implicitly acknowledging the importance of their own joint narrative. I couldn’t give any advice because they must write the narrative themselves, using the ink of the circumstances in which they find themselves. The sort of notions of identity in which philosophers and courts might be interested are probably of little help to them. If Antoine chooses to say that he loves the old Mary, or the new one, or a blend of the two, I wouldn’t presume to disrupt his/their story by interrupting and saying that he was wrong.